从“血不利则为水”探讨乳腺癌相关淋巴水肿

导致血不利的原因一是不足,即由于气、血、津、液等物质的缺乏致无源行血;一是不通,即水、湿、痰、饮、瘀、食积、火郁、内风、外伤等病理因素阻滞,致血行不畅。血瘀经脉之内,则水亦瘀积脉中,致脉络胀满,形成水肿。乳腺癌术后患者,金刃本已损伤血脉,术后的放疗、化疗又属祛邪之法,故机体元气受损,气虚无力行血,血运行不畅,导致患侧上肢水肿。故治疗乳腺癌相关淋巴水肿时,应当血水同治,即活血利水之法要贯穿始终。先病血而后病水者,可以活血化瘀为主,利水为辅;先病水后病血者,则以利水消肿为主,酌加活血养血之品。但需要注意的是:①临证时切不可拘泥于单纯的活血利水法,而忽视乳腺癌相关淋巴水肿(breast cancer related lymphedema,BCRL)患者机体本身的状况。②临证勿忽视五脏与血、水的关系,以及肺、脾、肾、三焦与水肿的内在关系。③可多种方法联合运用,审证求因,标本同治。BCRL术后宜补气活血,通脉利水;术后兼化疗者可疏肝健脾、利水消肿;早期可在活血利水基础上,侧重利湿消肿,后期多湿聚为痰,治疗侧重化痰软坚。

Discussion About Breast Cancer-Related Lymphedema Based on"Blood Stasis Causing Edema"

One of the reasons for the blood stasis is insufficiency,that is,the lack of qi,blood,fluid and other substances leads to no resources of blood circulation.Another reason is obstruction,that is,water,dampness,phlegm,drinking,blood stasis,food accumulation,fire stagnation,internal wind,trauma and other pathological factors block inside the body,resulting in poor blood flow.Blood stasis in meridians leads to water stasis and further develops into edema.The blood vessels of the patients with breast cancer operation have been damaged,and the postoperative radiotherapy and chemotherapy belong to the method of removing pathogenic factors.Therefore,the vital energy of the body is damaged,the qi deficiency is unable to move blood,and the blood flow is not smooth,resulting in the edema of the affected upper limbs.Therefore,in the treatment of breast cancer-related lymphedema,blood and water should be treated together,that is,the method of promoting blood circulation and promoting water circulation should be carried out through the whole course.For the patient who first suffers blood stasis then water stasis,the treatment should mainly focuses on promoting blood circulation and removing blood stasis,supplemented by promoting urination.For the one who first suffers water stasis then blood stasis,the treatment should mainly focuses on promoting urination to remove edema,properly added the medicinals for promoting blood circulation and nourishing blood.However,we should pay attention to the following points:j In clinical practice,we should not stick to the simple method of promoting blood circulation and promoting water circulation,but ignore the condition of breast cancer related lymphedema(BCRL)patients themselves.k Do not neglect the relationship between the five zang organs and blood and water,as well as the internal relationship between lung,spleen,kidney,triple energizer and edema.l A variety of ways can be used to examine the causes,treat the root and branch simultaneously and treat based on the syndrome.After BCRL operation,it is better to invigorate qi and blood circulation,dredge blood vessels and promote water circulation;after operation and chemotherapy,it is better to disperse the liver,strengthen the spleen,promote water circulation and reduce swelling;in the early stage,it is better to promote urination and remove edema based on promoting blood circulation and promoting water circulation;and in the later stage,more dampness will gather into phlegm,and the treatment will focus on resolving phlegm,and softening hard masses.